History: When I first started doula work, sometimes I was permitted in the operating room at Greenville Memorial with my client. It was still hit or miss. However in recent years, the “rule” is only one support person for cesarean births. Until now.

Much to my surprise, at my last Greenville Memorial birth, JoAnn the trailblazing midwife, told me I was going back. I threw on some (cloth!) scrubs and Louise, a favorite nurse of mine, insisted I go with my client as she was being wheeled back.

That was the one-up.

Whenever I’ve been allowed back, I’ve first waited with dad until mom was prepped. This time, I stayed with mom the entire time. I was able to wipe a few tears while she waited, hold her while she received her spinal anesthesia, and talk with her as the surgery began. After the surgery, when dad left for a little while with their baby, I stayed until she was wheeled into recovery.

True continuous care.

Even better? JoAnn says the policy has now changed to allow two support people into the operating room.

I’m not saying I’m responsible for that. I’m just saying I’m glad I didn’t trip and face plant on mom’s uterus or something. Ruin it for everybody, you know? 🙂

Now, look at this adorable poppet enjoying skin-to-skin time with daddy in the operating room. Don’t worry, she got lots of immediate skin-to-skin time with mama first. Mom voluntarily permitted dad a turn.

It looks like family-centered cesarean birth will be standard care now at Greenville Memorial.

I am more and more impressed with Greer Memorial’s cesarean practices. If I had to plan a cesarean, that’s the place I’d give birth.

There are four OBs who attend cesarean births at Greer so the policy and practice is fairly cohesive. None of the “well, if you get dr. so and so, then expect x, y, z.”

I was honored to attend a repeat client’s planned cesarean. I use the term “planned” loosely since her darling boy decided to come early. Just to keep us on our toes! Come to think of it…her last “planned cesarean” also had me rushing to the hospital. Her babies don’t like to be told what to do, I suppose.

Here is her birth in pictures. I only took 150 snapshots so it was easy to narrow it down to a few. Hehe.

Top reason I prefer Greer? Doulas can enter the sacred operating room. And I dig the nurse’s scrubs instead of the paper ones. In this picture, I’m waiting with dad. The mom goes back first and there is about a 30 minute wait while she receives her spinal anesthesia and her stats are monitored. Dad was nervous even though it wasn’t his first rodeo so we talked about our kids while we waited.

Now we’re in the operating room. Notice mom’s arms are not strapped down.

Dr. Danielle Harris is the OB. She is lovely; relaxed and accessible. I remember my first birth with her four years ago. I suggested something wildly uncommon and she responded with a “hey, let’s try it!”

(which is interesting because I’ve heard all sorts of reasons from other OBs as to why they can’t delay cord clamping during a cesarean)

So, who’s this guy? He’s the pediatrician on call. Typically, the pediatrician or neonatologist examines the baby in the warmer immediately after birth. When he walks in, Dr. Harris tells him, “Mom would like immediate skin-to-skin with her baby.” And he says, “Fine by me.”

(again, I’ve heard all sorts of interesting reasons why this can’t happen: a nurse will have to rotate out in order to hand baby to mom or it’s too darn cold in the operating room).

Now you’ll see how fantastic it is that mom’s arms are free.

Beautiful. Mom will never forget this moment. And perhaps, just as important, significant aspects of bonding, breastfeeding, heartrate and thermal regulations are happening in this moment.

A little while later, that laid back pediatrician asks if he can just take a quick listen to baby’s heartbeat. He does so without disturbing mom or baby and then steps back once more.

Twenty minutes after the birth, as they prepare to transfer mom to her room, Dad gets in on the skin-to-skin.

Focus on the calm, alert baby. Do not focus on the bloody gauze behind him.

Then mom is transferred to her hospital bed via a clever inflatable people-mover blown up with a shop vac. Fascinating stuff, hospital ingenuity. Side-note, many nurses wrap hep-locks in Glad press ‘n seal wrap so they won’t get it wet in the shower. Necessity is the mother of invention.

The hospital bed returns to mom’s original room where she will stay until she goes home. There are no recovery or postpartum rooms at Greer. There is no nursery either.

Mom gets down to the first order of business.

I don’t attend many cesarean births. I’m honored when I am invited to a planned cesarean as part of the team. Many thanks to this sweet family for sharing their positive birth experience with the community.

Truth? Sometimes I’m baffled by my work as a doula. I’m confused by the mystery that my presence makes an impact. Especially when I don’t *do* anything.

Take Julia’s birth. I left Julia’s birth feeling like her three year old did more than I did. I mean, really. What did I possibly offer to that family? And then later, Julia’s husband says I was worth every penny.

It made no sense.

Or Melissa’s birth. I fanned her. With a manilla folder. That’s about all I did. And then later, she says she couldn’t have done it without me.

It made no sense.

I read about the early studies on doula support. In those double-blind randomized controlled trials, the laboring women had no idea that the extra woman in the room was a doula. They’d never met before. Yet, their birth outcomes were significantly better than the births that did not get the “extra person.”

It made no sense.

Nearly 8 years into this gig, I think I’m maybe beginning to understand how doulas work.

We’re pacers.

I’m reading an incredible book titled The Worst Is Over: What to Say When Every Moment Counts. I bought the book thinking it would help with my kids. Norah has an anxious tummy and Cedar is ever catapulting from high places. I never imagined how it might relate to my birth work. But, of course, women in childbirth are in an altered state of consciousness just like people who experience trauma. Childbirth is NOT trauma and not always even painful but the brain does go into an altered state. Women in childbirth are often dreamy, time becomes hazy, thoughts may be confusing, suggestions plant deeply. I already knew how important language is for birthing women but this book took it up 10 notches. And it taught me about pacers.

So what’s a pacer?

You know how you modify your body language, voice, words to become more in sync with others? It’s a normal part of communication. Or sometimes a strong personality can change the entire mood of the room when that person is having a bad day. The author describes pacing as “our natural human tendency to tune in to others nearby by matching our words and our behaviors to theirs.”

The author talks about the importance of pacers when people are afraid, hurting, in shock, etc. Pacing builds confidence, healing, comfort, rapport, and cooperation.

How does this work in childbirth?

Nancy is deep in the birth zone. She is in an altered state of consciousness. She is barefoot in the hospital shower–a state that would disturb her any other time. Usually a very modest woman, Nancy is naked. Her husband, in swim trunks, supports her physically in the shower. What am I doing? I’m leaning against the wall, offering a sip of water from time to time. I don’t say a word. But here is the non-verbal pacing that is happening: Nancy locks eyes with me as she welcomes each surge. My eyes are confident, grounded, and full of love. She knows I’ve done this before. My eyes tell her everything is normal. What else? My posture is relaxed. I’m not carrying tension or shedding adrenaline. As we lock eyes, I take a deep cleansing breath and release it slowly. She mimics me. I smile.

Sarah sits on her birthing ball leaning on her king-sized bed. Her husband rubs her back. Bon Iver plays in the background and the rain is falling outside. There is nothing for me to do so I sit in the corner and knit. Sometimes, Sarah looks over at me and I smile. My calm, slow knitting reassures her that all is progressing perfectly and there is no rush.

Heather’s labor is showing signs that baby is not in an optimal position. I show her a technique to lunge during her waves. Her husband stands behind her providing extra support. I stand in front of her and lunge with her. We are exactly in sync as we lunge and lunge and lunge some more.

What makes doulas uniquely suited for pacing?

The doula’s focus is entirely on the mom. Midwives are amazing pacers but they sometimes have other important tasks that may come first or interrupt: monitoring baby, checking mom’s blood pressure, etc. Particularly in those rare cases of emergency, it is vital to have a pacer who can remain focused on mom.

Dads, close friends, family members are not always the best pacers. Why? They’re emotionally caught up with the experience. They should be! I remember catching a glimpse of my mother’s concerned face at my first birth. It did not reassure me. Sometimes dad isn’t sure if what his wife is feeling is normal and his face can mirror it. And the birthing mom’s spidey senses can smell fear and uncertainty.

I am excited to share Moira’s birth story! Moira experienced a completely comfortable birth using Hypnobabies. I’ve never seen doctors and nurses behave the way they did at her birth. She refused to be checked for dilation and she was so relaxed that her care providers didn’t believe she was very far along. I had to physically go find a nurse (twice–she didn’t come the first time) because the baby was almost born! Moira had the Hypnobabies sign on her hospital door and once everyone realized that she really was about to give birth, curious nurses quietly filed in to watch. The doctor waited for the placenta to deliver before clamping the cord. Later the doctor told me, “I just got caught up in the physiological process!”

11am: First school day wearing her glasses. Turns out Norah is far-sighted! That explains why she has no difficulty reading billboards but all sorts of trouble reading books. “Mom, the words are all blurry and my eyes are so tired.” Doh.

12pm: Boo-boo. It’s incredible how much blood results when a 3 yr old tries to sharpen her finger in a pencil sharperner.

1pm: Lunch

2pm: Strawberries, strawberries everywhere!

3pm: Bird study

4pm: Calling in the creepy door-to-door guys claiming to be ADT. I took pictures of the three guys, too. I wouldn’t let them walk up my driveway.

5pm: Waiting for her Daddy/Daughter Date

6pm: Story of my life. Also, I need to dust.

7pm: Norah and her friend, Veda, at the musical production, “Oliver.” Last show is tonight…GO SEE IT!